Prescription that fail to consider patient's stated allergy

[waynechai]

What is the name of your state? FL

I have G6PD deficiency. And among the list of drugs to avoid is Sulfonamides. I have been prescribed Celebrex, and finishing the samples (6-days dosage) that I was given, I went to the pharmacy to fill my prescription. There I was asked whether I am allergic to any sulphur drugs? I only know that I have G6PD and not really fully aware of the drugs that I have to avoid. I informed the pharmacist accordingly and he continued to fill my prescription anyhow.

Upon reaching home, I check the web, and realised that it is recommended for people allergic to Sulfonamides not to take Celebrex. I have not seen any side effect yet, but I am extremely worried. I am not sure if the doctor(s) have taken into my G6PD considerations when prescribing Celebrex. And I am not sure what possible side effects that could arise.

That really enrage and disturb me as my doctor has appaprently failed to take reasonable care and exercise skill expected of him.

Legally speaking, is my doctor in anyway liable?

 

[vrzirn]

I suppose you are not allergic to the Sulfonamides so what is your problem?
Celebrex is a non-steroidal anti-inflammatory drug usually prescribed for osteo-arthritis or rheumatoid arthritis. Or, perhaps you have severe menstrual cramps.
G6Pd deficiency is a fairly common cause of anemia with medicine as a common precipitating factor for hemolysis. Such complications can be avoided with early recognition of the disease and avoiding 'indiscriminate' use of medicine. You are also supposed to avoid 'indiscriminate' use of aspirin, Motrin, tylenol. It is very important that you definitely refrain from sniffing amyl nitrate poppers.
If you feel uncomfortable with this drug, stop taking it! It seems that the trial run with the samples would have already created a problem if one were lurking in your red blood cells. If you are so "enraged", by all means take your long-suffering doctor to court and then find another internist.
Make it Small Claims Court and sue the pharmacist as well. Remember though, the only thing small about SCC is the size of the claim, You still need the same proof of damages. Ask for your money back for the pills.

 

[rmet4nzkx]

Allergies and adverse drug reactions are a complex issue in both medicine and law, some may occur or be noticed as long as 1 year following taking the medication, so the fact that you were given a sample of a Rx and you had no reaction does not make your doctor liable as they are acting within their scope of practice and the pharmacist who is far more familar with Rx filled the Rx, so if anyone is liable it is the pharmacist who failed to confirm the Rx.

That having been said, it is very important that you learn about your disorder, what to avoid in Rx (approx 60% of Rx and OTC) foods and supplements and what to take to avoid anemia. The effects of "allergic" reactions may occur over time or with a combination of substances, so you may not have an immediate allergic reaction, however, due to the accumlative nature of these effects, you want to avoid them in the first place, including in your diet. Some supplements may help nuturalize the metabolites. It is especially important to avoid Sulfonamides or if you do, only for short well supervised lengths of time. You also need to know what the signs of reaction are both for drug reactions and specifically for G6PD and anemia.

If you have RA there may be other means of pain management, also you may want to be tested for A1AD as this affects collagen and it's treatment may also help RA without the potential reaction from sulfonamides. You may want to ask for a referral to a hemotologist.

 

[ellencee]

Oh for Pete's sake.
Celebrex was not contraindicated for any reason other than allergy to sulfonamides and it is not unreasonable for the physician to have given the patient a trial of the medication to see if it could be tolerated.

Of all of the medications for arthritis, Celebrex is one that protects the Cox-1 enzymes in GI tract, blood clotting mechanisms, and kidney function.

The OP took the medication without developing any sign or symptom of a reaction related to sulfonamide allergy and most likely received the benefits of relief of arthritic pain and loss of mobility. And, she wants to sue the MD for using caution and good sense and the pharmacist for filling a prescription that caused NO problem.

She doesn't need a different MD, not from what she posted. She needs an attitude adjustment.

EC

 

[waynechai]

EC,

Are you a medical doctor? Are you telling me that if I do not have any reaction to the medicine after taking a few dose, I would not suffer from any damage that the medicine will cause in future?

Is the doctor exercising good sense and caution?

I wasn't even told that Celebrex contained sulphonamides when I was prescribed that medicine. In fact, I am expecting to be told by the doctor that "You have G6PD, and perhaps you shouldn't take sulphonamides drugs. But Celebrex would help your condition, and chances of you reacting to the medicine is not high. Even it there is any reactions, it is unlikely to cause irrepairable damage. So let's try it and out and monitor.

If I was being told that, then perhaps I can agreed with you. Otherwise I have ample reason to believe that my G6PD condition was not taken into consideration at all when I was prescribed Celebrex.

Tell me, is that good sense and caution?

I would think that oen can only conclude that the doctor is negligent, and as of now, I am only keeping my fingers crossed that no damage has been done.

I do not honestly think that if you were in my position, you would think that you need an attitude change.
It is laughable.

 

[waynechai]

Hi VRIZIRN,

Why are you supposing that I am not allergic to Sulphonamides?

Like I said, I have G6PD deficiency, and as a result suhlphonamides is a drug group that I am supposed to avoid.

So far, I am fine taking the Celebrex for the first few days, ie before I was informed that Celebrex has sulphonamides.
I have however, still stop taking the drugs as I am of the opinion that my G6PD condition was not taken into considerations at all when the drugs were prescribed.

In fact, when I went to the pharmacy to fill in the prescription after I have finished my samples, the pharmacist asked if I am allergic to sulphur. I told him I was not sure, which at that point in time, I wasn't. I only know that I have G6PD deficiency and as a result, there's a group of drugs I am supposed to avoid.
And apparently, he has no idea what G6PD is, and I am really no expecting him to know. He is taking the attitude that since your doctor prescribed that for you, it would be fine.
Honestly, I agree with his perspective.

Thus, I am "enraged" with the doctor simply because apparently a stated allergy has been ignored when drugs were prescribed.
I cannot agree that he is trying to see if I have a reaction or not when I am not informed at all.

 

[waynechai]

Hi RMET4NZKX,

You stated exactly what I feared. That is, sulphonamides are drugs that I have been told to avoid (the doctor has been informed). And that the effects of any allergy may occur over time.
I am not sure if that will be the situation in my case, and that is definitely a fear on my aside.

I find it extremely naive and terrible to say that since I have relief from the joint pain I am suffering from as a result fo Celebrex, I am therefore adjudged to have attitude problem in being angry with my doctor.

The analogy is simple.
If the doctor gave you "cocaine" to make you feel good and therefore reduce your pain, he is right and you ahve no cause to complain? Mind that you are given cocaine without knowledge.
Or for that matter, you have gastric ulcer and your doctor is fully aware of that but prescribe an extremely strong pain killer which you have been specifically told to avoid. And he did so without telling you that is something you need to avoid, and that he knew of your gastric condition as well.
Does the fact that you are doing well with the medicine makes him cautious, having good sense?
What if like we said, the reaction comes much later?

Oh, by the way, what is RA?

 

[ellencee]

waynechai
You can rant and rave all you want and you can not take Celebrex. It does not change the pharmacological aspects of your situation and it does not suddenly make you damaged from having taken Celebrex. If years from now you suddenly break out in hives or go into shock from taking Celebrex in October 2004, please let vrzirn and me know. I'm sure it would make one hell of a medical and nursing journal article.

Get an attorney, like you can really find one to take this case, or follow vrzirn's instructions and go to small claims court to get your money back for the prescription. But whatever else you do...for now...shut up!

EC

 

[waynechai]

This is interesting.
Someone seems to be ranting and raving like a mad person here, and was still attempting to give advice.
And you don't even bother to understand the concern I have before letting your mouth into free salvo.

More interestingly. someone does not seem able to grasp the following:

1) I never ever talk about wanting to sue my doctor. I simply wish to know the american interpretation of law in terms of liability. Whether there's damage, and how much I can claim is all secondary. I do not want to doctor because of a more informed position that he is, bluff me further should there be a lack of professional ethic in the prescription of drugs supposedly to be avoided by the patient.

2) I said I am worried, and I definitely have reasons to since it it is a stated allergy. The first thing is would there be a delayed reaction, and I thought you spoke as if you are a doctor and that's why I ask you.

Please note that I am simply honestly having a concern, and questions in my mind and I thought that there would be people here to also honestly attempt to answer.
And I appreciate all the advices I have got so far, even your first advice. It is simply a matter of I needing clarifications.

I really cannot see how a person who fail to empathize with another person can actually think that he/she can give advice.

If you simply wish to say things to make yourself feel important and smart, and to do so by dismissing people, there's nothing anybody can do to stop you.
But, why don't you shut your gap first and stop make this place really filthy?

I wish you luck, never coming across a situation as I am in.
Stay healthy.
What goes around comes around.

But then I guess, you will call anybody to shut up even if you need advice. You are just too full of yourself.

 

[ellencee]

You are just too full of yourself

Boy, that's the truth. I'm just thankful it settled in all the right places!
EC

 

[ResIpsaLoquitur]

Celebrex and G6Pd Deficiency

Dear Waynechai,

I can understand your frustration. But I think there are some things you need to take into consideration and the first is that you get what you pay for: and the name of this site - freeadvice.com - speaks for itself. The answers people receive here are not coming from medical malpractice attorneys or doctors. Doctors don't give free advice and neither would any reputable medical malpractice attorney - not based on the scanty - and often contradictory - information that questioners include in their posts. Replies on this forum are filled with blanket statements; generalizations; open hostility and plain old fashioned misinformation.

That said - and I realize I will be chastized for my observations because I have not replied two or three thousand questions - I do have some thoughts on your "dilemma".

In your most recent post you state: "I never ever talk about wanting to sue my doctor" (sic). Yet in your original post you ask: "Legally speaking, is my doctor in anyway liable?" And inbetween the two, you express great anxiety about your health and say you are "enraged" at your doctor.

This is a medical malpractice forum. And 99.9% of the questions posed here come down to "Can I sue for XXX". Technically, every answer should consist of one sentence: "Maybe. Contact a reputable medical malpractice attorney." But people, myself included, who may have some degree of expertise or experience with the issue in question tend to - for whatever reason - want to share what they know - or, unfortunately, what they don't know - on the subject.

You have a genetic condition that almost half a million other Americans - the majority of them male and of African-American or Mediterranean descent - also live with. Anyone with a chronic disease or condition owes it to himself to gain as full an understanding as possible of whatever it is that makes their health concerns unique. Your posts suggest you really do not have a good understanding of G6PD or how it affects adult sufferers. A consultation with a hematologist - and continued monitoring if indicated - will give you not only peace of mind, but the knowledge to advocate your own healthcare.

As to the concerns included in your postings:

1) As far as I know - and as far as the Director of Hematology and Oncology at the University of Pennsylvania Medical School knows - Celebrex has never produced a hemolytic anemia related to G6PD. But this does not mean that you could not be the very first documented case.

2) And it does not mean that the symptoms of that hemolytic anemia could not conceivable appear months - or years - down the road if you continue to take Celebrex - or any drug that compromises your erythrocytes' (red blood cells) ability to withstand stress. If you have stopped the drug and are not experiencing any of the symptoms of anemia there is no scientific basis to think that this short course of Celebrex could be linked to problems you might have in the future: which is something you would know with better understanding of G6PD. For instance: there are differing degrees of G6PD. Although aspirin is one of the drugs that G6PD patients are warned not to take, clinically, it rarely produces a hemolytic event. Nothing in medicine is written in stone.

3) If the hematologist feels Celebrex is safe - but you continue to be "terrified", my best guess is that he or she will offer you the option of determining your hemoglobin at regular intervals to assuage your fears.

I hope I have been of some help and wish you good health

P.S. RA is Rheumatoid arthritis and if you had it you'd know what it was

 

[waynechai]

Hi Resipsaloquitur,

Thanks for your note. While you have not had 2000+ post, it is the quality and most importantly the intention behind posting that is most important.
I appreciate it.

I do realise after a while that this is a free advice forum, and what has people has to say about free advice? That it it is the most expensive advice.
So perhaps I should expect the sort of response I had received.

Well, I guess I would see a Hematologist as soon I can arrange for one.
I was never told I need to see one when I was told I had G6PD, which was about 15 years ago. I was simply handed a pamphlet which stated the drugs I am to avoid.

When I said I am enraged with this doctor, I was because I do expect doctors to be proficient to know about G6PD. If not, he should at the very least be responsible to find out before prescribing drugs which can be a problem.
In fact, I saw him today and informed he what he has done. And his response was that he is an orthoapedic and is thus not very well versed with G6PD and thus not sure if I can or cannot take Celebrex, and then recommended I go see a Liver specialist to have my G6PD follow up.

1) This is the second time I have had referral that doesn't make sense. (The first was when I wanted to see a Chiropractor for my aching back, and my GP recommended me to one who only see patients involved in auto insurance. Then this chiropractor recommended me to another one which turns out to be a pain speciialist. Not sure whether he can indeed help, and thus proceed with the appointment. This pain specialist cost me $260 telling me that's nothing he can do for me)
Liver specialist??!!

2) He doesn't know and he is prescribing the medicine to me? Am I supposed to know? And he asked if the pharmacist said anything to me when I went to have the prescription filled? Is he expecting the pharmacist to be responsible?

When people say they want to sue someone, they may be after the compensation they can get.

I am more interested in exposing such irresponsible actions, at least to me that is irresponsible.

 

[censored]

I'd just like to point out that you do not have an allergy to sulfonamides due to your G6PD deficiency. Thus, you would not have an allergic reaction to sulfa-containing drugs on that basis either.

What you have is a genetic defect, different problem altogether. As noted above, there have been no known hemolytic events in people with G6PD deficiency from taking Celebrex.

While the disorder is not uncommon, it's far too easy to overlook when prescribing. If I had it, I would remind both my doctor and my pharmacist each and every time I got a prescription for a new drug.

The best health care is a collaborative effort; for your own peace of mind, I'd suggest that in the future you take that extra step.